Merits And Demerits of Different Routes of Hysterectomy For Gynecological Conditions Without Uterine Descent

Objective:  To evaluate the merits and demerits of abdominal, vaginal and laparoscopic assisted vaginal hysterectomy and assess the outcome.  To study the best possible route of approach for hysterectomy with minimal complications for gynaecological conditions without uterine descent. Material And Methods Study design:An Observational and Prospective study was conducted at Gandhi Hospital Secunderabad, Telangana for two years from August 2014 to July 2016.Total 150 Patients who met inclusion criteria and surgically fit were selected from women admitted for hysterectomy for benign gynaecological condition. They were randomized into one of surgical procedure like total abdominal hysterectomy, vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy.50 cases were allotted to each group. The characters like age, parity, BMI, cases with previous cesarean section, uterine size and comorbid conditions like hypertention, diabetes were matched in all three groups. Then intra operative parameters like operating time, intra operative blood loss, visceral injuries were noted. Post operative parameters like post operative fever, urinary tract infections, D3 pain level index, Post Urinary tract, Post operative day of ambulation, Abdominal wound infection/vaginal cellulitis/local hematoma (if any), Fall in haemoglobin, Blood transfusion, Blood transfusion , Post operative hospital stay were noted in all three routes of hysterectomy and analyzed. Results: The operating time was shortest in TAH(65.38 mins)and longest (128.6 mins)in LAVH. Blood loss was more for VH and minimum for LAVH. Fall in Hb followed the same order VH(1.9gr%) > TAH 1.2g% > LAVH 0.76gr%.Blood transfusion was given in 5 cases (10%) cases in VH and 3 cases (6%) in TAH. There was no need of blood transfusion in LAVH. When intra operative visceral injuries were compared there was only one (2%) case of bladder injury identified under VH and TAH respectively. No visceral injuries were found in LAVH. Coming to post operative parameters it was observed that 10 patients (20%) in TAH, 4 cases (8%) in VH and only 2 patients (4%) in LAVH suffered from fever. The incidence of postoperative urinary tract infection and wound infection was high in TAH than VH and LAVH. Day 3 mean pain score was minimal in LAVH (2.02 cm) ,moderate in VH (3.7 cm) and maximum in TAH (5.8cm). Post operative ambulation was earlier in LAVH and VH compared to TAH. Mean Hospital stay was less in LAVH (4 Days) and VH (5 Days) when compared to TAH which was 9.8 Days. Conclusion: No procedure is 100% ideal. The ideal method can be chosen for a patient by skilled surgeon by discussing with his patient. Aims And Objectives Aim of the study:-To evaluate the merits and demerits of abdominal, vaginal and laparoscopic assisted vaginal hysterectomy and assess the outcome. To study the best possible route of approach for hysterectomy with minimal complications for gynaecological conditions without uterine descent. Objective of the study:•Comparing the intraoperative parameters. •Comparing the post operative parameters in total abdominal hysterectomy, undescended vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy.